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This is VAERS ID 412547

(NOTE: This result is from the 6/14/2014 version of the VAERS database)

Case Details

VAERS ID: 412547 (history)  
Form: Version .0  
Age: 0.2  
Gender: Male  
Location: Texas  
Vaccinated:2010-10-11
Onset:2010-11-26
   Days after vaccination:46
Submitted: 2010-12-13
   Days after onset:17
Entered: 2010-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH163AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E80082 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FBO93A / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal mass, Barium enema, Diarrhoea, Intestinal malrotation, Intussusception, Surgery, Vomiting
SMQs:, Acute pancreatitis (broad), Congenital, familial and genetic disorders (narrow), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: 783.3 FEEDING PROBLEMS, 530.81 GER, 579.8 FORMULA INTOLERANCE
Allergies:
Diagnostic Lab Data: BARIUM ENEMA + INTUSSUSCEPTION/MALROTATION
CDC Split Type: TX2010133PR

Write-up: STARTED WITH VOMITING AND DIARRHEA ON 11/26/2010. PRESENTED IN OFFICE ON 11/27/2010 WITH A SOFT, MOBILE SAUSAGE-SHAPED MASS IN LLQ/MID-ABDOMEN. SENT TO ER FOR EVALUATION. INTUSSUSCEPTION FOUND AND TRIED TO REDUCE TWICE WITHOUT SUCCESS. SURGERY DONE TO CORRECT. ALSO DISCOVERED MALROTATION WHICH REQUIRED SURGERY.


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